				<form id="contact-form" class="form form-validate" action="emailer.php" method="post">
				
					<h1>Contact Us</h1>
				
					<ul>
						<li id="li_1" >
							<label class="small" for="element_1">Name </label>
							<div>
								<input id="element_1" name="name" class="element text medium required" type="text" maxlength="255" value="" size="50"/> 
							</div> 
						</li>	
						
						<li id="li_1_2" >
							<label class="small" for="element_1_2">Email </label>
							<div>
								<input id="element_1_2" name="email" class="element text medium required email" type="text" maxlength="255" value="" size="50"/> 
							</div> 
						</li>
												
						<li id="li_3" >
							<label class="small" for="element_2">Your Message </label>
							<div>
								<textarea id="element_2" name="message" class="element textarea medium" cols="50" rows="8"></textarea> 
							</div> 
						</li>
						
						<li id="li_4" >
							<label class="small" for="element_3">I am interested in </label>
							<div>
								<select class="element select medium" id="element_3" name="Interest"> 
									<option value="">- Please Select -</option>
									<option value="General Inquiry">General Inquiry</option>
									<option value="Saying Hello">Saying Hello</option>
									<option value="Networking">Networking</option>
									<option value="Other">Other</option>
								</select>
							</div> 
						</li>
											
						<li id="li_5" >
							<label class="small" for="element_4">How did you find us? </label>
							<div>
								<select class="element select medium" id="element_4" name="how"> 
									<option value="">- Please Select -</option>
									<option value="Newspaper">Newspaper</option>
									<option value="Magazine">Magazine</option>
									<option value="Friend">Friend</option>
									<option value="Radio">Radio</option>
									<option value="Search Engine Results">Search Engine Results</option>
									<option value="Banner Ad">Banner Ad</option>
									<option value="Online Directory">Online Directory</option>
									<option value="Other">Other</option>
								</select>
							</div> 
						</li>
						
						<br><br>
							
						<div class="buttons">						    
							<input id="saveForm" class="button_text" type="submit" name="submit" value="Submit to Email" />
						</div>
											
						<br><br>
						
					</ul>
				</form>
 				
				
				
			
				